Tissue repair system

ABSTRACT

A bone anchor includes an anchor body configured to be retained within bone. The anchor body includes a restrictor defining an opening having a first portion for permitting passage of a member therethrough, and a second portion restricting passage of the member therethrough. The member is movable between the first and second portions in a direction non-parallel to a direction of passage of the member through the opening. The restrictor includes an edge lining the opening oriented obliquely to a direction of passage of the member through the opening. The anchor body includes one or more resilient members with sharp, proximal edges for penetrating bone tissue.

BACKGROUND

This invention relates to tissue fixation devices and methods for tissuerepair.

Fibrous tissues, such as ligaments and tendons, can detach from bone.The detachment can be repaired using sutures. It is known to fix afibrous tissue to bone by inserting a suture anchor through the fibroustissue and into the bone and knotting suture attached to the anchor totie down the fibrous tissue to the bone. Tying suture knots in minimallyinvasive surgical procedures commonly requires a skilled surgeon and/orspecialized equipment.

SUMMARY

According to one aspect of the invention, a bone anchor includes ananchor body configured to be retained within bone and to selectivelyrestrict movement of a flexible member coupled to the bone anchor suchthat after implantation, the flexible member can be moved through theanchor body in a first direction while, without the aid of an enlargedportion on the flexible member, e.g., a knot, movement in a second,opposite direction can be restricted.

Embodiments of this aspect of the invention may include one or more ofthe following features. The bone anchor includes a restrictor configuredto engage the flexible member to selectively restrict movement of theflexible member. The restrictor is configured to engage the flexiblemember at a substantially arbitrary position along a length of theflexible member. The anchor body defines an opening through which theflexible member can be moved, and the restrictor is configured to engagethe flexible member to selectively restrict passage of the flexiblemember through the opening. The restrictor defines at least a part ofthe opening, for example, a narrower portion of the opening than anotherportion of the opening.

In an illustrated embodiment, the restrictor includes a sloped surfaceconfigured to compress the flexible member to permit passage of theflexible member through the opening, and opposing edges for engaging theflexible member to limit passage of the flexible member through theopening.

The bone anchor includes a second restrictor configured to engage theflexible member to selectively restrict passage of the flexible memberthrough the opening. The restrictors are oppositely directed.

The anchor body includes a pair of legs, a bone-engaging ridge forretaining the bone anchor in a bone hole, and a post about which theflexible member is positionable. The anchor body is a unitary body.

According to another aspect of the invention, a tissue repair systemincludes a first anchor body including a member that engages bone toretain the anchor within the bone and a second anchor body including amember that engages bone to retain the anchor within the bone. Theanchor bodies each define an opening for receiving suture and arestrictor forming a one-way passage through the opening. The anchorbodies are coupled by a suture extending through the one-way passages.

According to another aspect of the invention, a bone anchor includes ananchor body configured to be retained within bone and to receive aflexible member such that after implantation of the anchor body withinbone, the flexible member can be moved through the anchor body while,without the aid of an enlarged portion on the flexible member,subsequent movement of the anchor body can be restricted.

According to another aspect of the invention, a tissue repair systemincludes a flexible member, and first and second bone anchors coupledtogether by the flexible member. Each bone anchor includes an anchorbody configured to be retained within bone. At least one of the boneanchors is configured to receive the flexible member such that theflexible member can be pulled to shorten a length of the flexible memberbetween the bone anchors, while, without the aid of an enlarged portionon the flexible member, subsequent lengthening of the flexible memberbetween the bone anchors can be restricted.

According to another aspect of the invention, a bone anchor includes ananchor body configured to be retained within bone. The anchor bodydefines a one-way passage configured to pass a suture in a firstdirection and restrict passage of the suture in a second directionopposite the first direction.

According to another aspect of the invention, a bone anchor includes ananchor body configured to be retained within bone. The anchor bodyincludes a restrictor defining an opening having a first portion forpermitting passage of a member therethrough, and a second portionrestricting passage of the member therethrough without the aid of anenlarged portion on the member.

According to another aspect of the invention, a method includes placingan anchor in bone, moving a flexible member through the anchor in afirst direction, and restricting movement of the flexible member throughthe anchor in a second, opposite direction.

Embodiments of this aspect of the invention may include placing a secondanchor in bone. The second anchor is coupled to the first anchor by theflexible member. The step of moving the flexible member in the firstdirection shortens a length of the flexible member between the anchors.

According to another aspect of the invention, a bone anchor includes ananchor body configured to be retained within bone. The anchor bodyincludes a restrictor defining an opening having a first portion forpermitting passage of a member therethrough, and a second portionrestricting passage of the member therethrough. The member is movablebetween the first and second portions in a direction non-parallel to adirection of passage of the member through the opening.

Embodiments of this aspect of the invention may include one or more ofthe following features.

The restrictor includes one or more edges lining a wall of the opening.The edge is oriented obliquely to a direction of passage of the memberthrough the opening. Some of the edges are oriented at the same obliqueangle relative to the direction of passage of the member through theopening, and some of the edges are oriented parallel to each other.

A dimension of the second portion is narrower than a diameter of themember. The opening is triangular in shape. The anchor is configuredsuch that the member is movable between the first and second portionssubstantially perpendicularly to a direction of passage of the memberthrough the opening.

In an illustrated embodiment, the anchor body includes a tissuepenetrating tip, and a central body member with a driver coupling. Theanchor body includes one or more resilient members with sharp, proximaledges for penetrating bone tissue. The anchor body is a unitary body.

According to another aspect of the invention, a tissue repair systemincludes a first bone anchor with an anchor body configured to beretained within bone, and a second bone anchor with an anchor bodyconfigured to be retained within bone. A flexible member couples thefirst and second bone anchors. At least one of the first and secondanchor bodies includes a restrictor defining an opening having a firstportion for passage of the flexible member therethrough, and a secondportion limiting passage of the flexible member therethrough. Theflexible member is movable between the first and second portions in adirection non-parallel to a direction of passage of the member throughthe opening.

According to another aspect of the invention, a bone anchor includes ananchor body configured to be retained within bone. The anchor bodyincludes a restrictor defining an opening for passage of a membertherethrough. The restrictor includes an edge lining a wall of theopening oriented such that upon movement of the member through theopening in a first direction, the member is also moved non-parallel tothe first direction.

Embodiments of this aspect of the invention may include the edge beingoriented such that upon movement of the member through the opening in asecond direction opposite the first direction, the member is also movednon-parallel to the second direction. The restrictor includes a secondedge lining a wall of the opening. The second edge is oriented such thatupon movement of the member through the opening in a second directionopposite the first direction, the member is also moved non-parallel tothe second direction.

According to another aspect of the invention, a method includes placingan anchor in bone and moving a member between first and second portionsof an opening in the anchor in a direction non-parallel to a directionof passage of the member through the opening.

Embodiments of this aspect of the invention may include one or more ofthe following features.

The method includes engaging the member with an edge lining the opening.Moving the member to the second portion includes moving the member in adirection substantially perpendicular to a direction moved by the memberthrough the first portion. A second anchor coupled to the first anchorby the member is placed in the bone.

Advantages of the invention may include permitting surgeons with varyingskill levels to straightforwardly reattach tissue to bone in open orclosed surgical procedures. The surgeon is able to fix a fibrous tissueto bone using an appropriate tension simply by pulling a suture receivedby the bone anchor in a first direction. Since the bone anchors of thepresent invention limit subsequent movement of the suture in theopposite direction, the surgeon is able to easily select the appropriatetension.

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the invention will be apparent from thedescription and drawings, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1 is a diagrammatic illustration of a system for reattachingfibrous tissue to bone;

FIG. 2A is a perspective view of a bone anchor;

FIGS. 2B and 2C are side views of the bone anchor of FIG. 2A;

FIG. 2D is a cross-sectional view of the bone anchor of FIG. 2A takenalong lines 2D—2D of FIGS. 2B and 2C;

FIGS. 2E and 2F are respectively top and bottom views of the bone anchorof FIG. 2A;

FIG. 3A is a perspective view of an alternative embodiment of a boneanchor;

FIGS. 3B and 3C are side views of the bone anchor of FIG. 3A;

FIG. 3D is a cross-sectional view of the bone anchor of FIG. 3A takenalong lines 3D—3D of FIGS. 3B and 3C;

FIGS. 3E and 3F are respectively top and bottom views of the of the boneanchor of FIG. 3A;

FIG. 3G is another perspective view of the bone anchor of FIG. 3A;

FIG. 4A is a perspective view of another alternative embodiment of abone anchor;

FIG. 4B is a side view of the bone anchor of FIG. 4A;

FIG. 4C is a cross-sectional side view of the bone anchor of FIG. 4Ataken along lines 4C—4C of FIG. 4B;

FIG. 4D is another side view of the bone anchor of FIG. 4A;

FIG. 4E is a cross-sectional side view of the bone anchor of FIG. 4Ataken along lines 4E—4E of FIG. 4D;

FIG. 4F is another side view of the bone anchor of FIG. 4A;

FIG. 4G is a cross-sectional side view of the bone anchor of FIG. 4Ataken along lines 4G—4G of FIG. 4F;

FIG. 5 is a cross-sectional side view of the bone anchor of FIG. 4Ashown with a suture coupled thereto; and

FIG. 6 illustrates the bone anchor of FIG. 4A in use.

DETAILED DESCRIPTION

Referring to FIG. 1, a tissue repair system 8 for attaching soft tissue22, e.g., tendon, ligament, or cartilage, to bone 20 includes a flexiblemember, e.g., suture 10, coupled to first and second bone anchors 16,18. Suture 10 includes contiguous suture portions 10 a, 10 b and 10 c.In use, bone anchors 16, 18 are located within holes 11, 13 in bone 20,with first suture portion 10 a extending from bone anchor 16 through ahole 30 in tissue 22 to a first suture end 6, second suture portion 10 bspanning between bone anchors 16, 18 and lying along an outer surface 23of tissue 22, and third suture portion 10 c extending from bone anchor18 through a hole 32 in tissue 22 to a second suture end 7.

Bone anchors 16, 18 each include a first engagement system 17 throughwhich suture 10 is threaded. After implantation in bone 20, thephysician pulls on one or both of the ends 6, 7 of suture 10 to shortenthe length of suture portion 10 b, thus securing tissue 22 against bone20. Engagement systems 17, discussed further below, couple suture 10 tobone anchors 16, 18 and limit possible loosening of tissue repair system8 following tissue securement.

Referring to FIG. 2A, bone anchors 16, 18 each have a flat, distal tip15 and a pair of legs 31, 33 extending proximally from tip 15 to aproximal end 26. Legs 31, 33 are generally part-circular in shape (FIG.2E) with a region of increased outer diameter defined by a series ofradial ridges (here three ridges 19 a, 19 b, 19 c shown) that engagebone tissue to resist the withdrawal of the anchor from the bone hole.Each ridge 19 a, 19 b, 19 c has a sloped distal face 2, a proximal face3 that is substantially normal to the long axis, X, of bone anchors 16,18, and a bone engaging edge 4 (FIG. 2B) defined at the intersection offaces 2 and 3.

Engagement system 17 includes a pair of restrictor cleats 40, 50 at theproximal end 26 of legs 31, 33. Legs 31, 33 have inner walls 31 a, 33 a(FIG. 2B), respectively, that define a slot opening 35 therebetweenextending from proximal end 26 to a distal chamber 60. Located withinchamber 60 is a winding post 62. The open sides of slot opening 35provide easy access to winding post 62 to aid in threading suture 10around post 62, though the sides need not be open. Cleats 40, 50 act toselectively restrict passage of suture 10 through opening 35, asdescribed further below.

As shown in FIG. 2D, winding post 62 extends into chamber 60 from a wall61 at a back side 16 b of anchor 16. Winding post 62 and wall 61 aretapered inwardly toward distal tip 15 to provide a smooth, tapereddistal portion. Chamber 60 circumscribes winding post 62, and is open ata front side 16 a of the bone anchor to aid in threading suture 10through anchor 16. Suture 10 is threaded through anchor 16 such that thesuture passes through cleat 50 and opening 35, into interior chamber 60and around winding post 62, then through opening 35 and cleat 40.Winding post 62 contacts and retains suture 10 within interior chamber60, and is of sufficient mechanical strength to withstand tensionapplied to suture 10.

Referring to FIGS. 2B and 2C, cleat 40 is formed by an opposing pair ofprotrusions 40 a having proximal faces 42, 44 that define a narrowerportion 35 a of channel 35 therebetween, and distal faces 46, 48 thatdefine a wider, sloped portion 35 b of channel 35 therebetween. Cleat 50is oriented opposite of cleat 40 with an opposing pair of protrusions 50a having distal faces 52, 54 that define a narrower portion 35 c ofchannel 35 therebetween, and proximal faces 56, 58 that define a wider,sloped portion 35 d of channel 35 therebetween. Proximal faces 42, 44have opposing edges 43, 45 (defined by the proximal corners of faces 42,44), and distal faces 52, 54 have opposing edges 53, 55 (defined by thedistal corners of faces 52, 54). Each opposing pair of edges 43, 45 and53, 55 is separated by a separation distance that is substantially equalto or smaller than the diameter of suture 10.

Movement of suture 10 through sloped portions 35 b, 35 d of cleats 40,50 acts to compress the suture such that the suture can pass throughnarrower portions 35 a, 35 c, respectively, when pulled in the directionof arrow 70 (FIG. 1). However, loosening of suture 10 (passage of suture10 through the cleats in a direction opposite arrow 70) is limited byopposing edges 43, 45 and 53, 55 catching on uncompressed suture 10 suchthat the suture does not pass through the cleats. In effect, cleats 40,50 form a one-way passage.

Referring again to FIG. 1, suture 10 is threaded through anchors 16 and18 such that from suture end 6, suture portion 10 a passes through cleat40 in anchor 16 to post 62, suture portion 10 b extends from post 62through cleat 50 in anchor 16, then through cleat 50 in anchor 18, topost 62, and suture portion 10 c extends from post 62 through cleat 40in anchor 18 to suture end 7. This permits the suture to pass throughthe cleats (with the sloped portions of the cleats compressing thesuture such that the suture can pass through the narrow portions of thecleats) when ends 6, 7 are pulled in the directions of arrows 70, 72,respectively, to shorten suture length 10 b, but resists passage throughthe cleats (by the opposing edges of the cleats catching on uncompressedsuture) when a load tending to lengthen suture length 10 b is placed onthe suture.

In use, the operator implants first and second bone anchors 16, 18 into,e.g., a predrilled hole in bone 20 through tissue 22 (and an overlayingcartilage layer, if present) by, e.g., applying a compressive ortorsional load to members 16, 18 as appropriate. The operator then drawsone or both ends 6, 7 of suture portions 10 a, 10 c in the direction ofarrows 70, 72 to shorten the length of suture portion 10 b between firstand second bone anchors 16, 18. Suture portion 10 b draws tissue 22toward bone 20. The anchors can be supplied to the operator with suture10 prethreaded to through anchors 16, 18, or the operator can threadsuture 10 through the anchors.

When suture portion 10 b is sufficiently taut, the operator releasesand/or cuts the free ends of the suture extending from the soft tissue.Although, during healing, a patient may apply forces that tend to drawtissue 22 away from bone 20, engagement systems 17 resist thelengthening of suture portion 10 b. In particular, cleats 40, 50restrict passage of the suture portion 10 c in the direction opposite toarrow 72 and suture portion 10 a in the direction opposite to arrow 70.Moreover, cleats 40, 50 engage and restrict the passage of suture 10 ata substantially arbitrary position along the length of suture 10. Inother words, there is no need, e.g., to clamp suture 10 with anothermember, or have an enlarged portion such as a knot in suture 10 torestrict the passage of suture 10 through the cleats. Cleats 40, 50 thusselectively restricts movement of suture 10 by allowing the passage ofsuture 10 through the cleats in a first direction while subsequentpassage of suture 10 in a second, opposite direction is restricted.

Other embodiments are within the scope of the following claims. Forexample, referring to FIGS. 3A-3F, particularly to FIGS. 3A and 3D,rather than a post 62 extending from a side wall, an alternate boneanchor 67 includes a central member 120 with side posts 112 a, 112 blocated in chamber 60. Side posts 112 a, 112 b taper inwardly to providea smooth, tapered distal portion. The outer dimension of side posts 112a, 112 b is less than the diameter of chamber 60 such that channels 110a, 110 b, respectively, are formed about side posts 112 a, 112 b, whilethe outer diameter of central member 120 is equal to the diameter ofchamber 60. Posts 112 a, 112 b and central member 120 defines atransverse passage 87 (FIG. 3G) for passage of suture from channel 110 ato 110 b. Side posts 112 a, 112 b have a half-moon shape such that acircular suture passage 87 is formed. Other side posts shapes arepossible. Suture 10 passes through cleat 40 to channel 35, to channel110 a and around post 112 a to passage 87, through passage 87, tochannel 110 b around post 112 b to channel 35, and through cleat 50.

Referring to FIG. 4A, a bone anchor 200 includes a central member 230, adistal tip 215, and a series of proximally extending, radial wings 219a, 219 b, 219 c, 219 d surrounding central member 230. Central member230 includes a restrictor in the form of a suture guiding throughchannel 235 that selectively restricts passage of suture therethrough,as described below. Distal tip 215 is conical in shape and has a tissuepenetrating point 215 a. Radial wings 219 a, 219 b, 219 c, 219 d arejoined at a distal end 221 of the wings to a proximal end 216 of distaltip 215, and resiliently flare outwardly from central member 230 in aproximal direction. Each wing has a sharp proximal edge 219 a′, 219 b′,219 c′, 219 d′ for digging into bone tissue to resist withdrawal ofanchor 200 from the bone. Wings 219 a, 219 b, 219 c, 219 d are inwardlydeformable toward central member 230 in response to radial compression,such as during insertion into a generally circular opening or hole inbone formed, e.g., by insertion of distal tip 215 into the bone. Centralmember 230 defines a proximal opening 240 for receiving a drive tool,not shown, for pounding anchor 200 into bone.

Referring to FIGS. 4B-4G, suture guiding channel 235 has a generallytriangular cross-section with a proximal apex 225, a distal base face227, and a pair of side faces 228 a, 228 b. Side faces 228 a, 228 bconverge proximally forming a distal portion 237 of channel 235 that iswider than the diameter of the suture, such that the suture can passfreely therethrough, and a proximal restricting portion 239 of channel235 that is narrower than the suture diameter to restrict passage of thesuture therethrough. Referring particularly to FIGS. 4C and 4E, baseface 227 follows an arcuate path through central member 230, as doesapex 225 at the intersection of side faces 228 a, 228 b. As illustrated,the radius of curvature of the path of apex 225 though central member230 is approximately equal to one half the diameter of central member230. The curvature of apex 225 presents an atraumatic surface for thesuture to rest against when pulled taught, as discussed below.

Side faces 228 a, 228 b are each lined by a series of grooves 250 a, 250b, 250 c, 250 d. Though four grooves are shown, one or more grooves canbe employed. As illustrated, grooves 250 a, 250 b, 250 c, 250 d arerelatively uniformly oriented with respect to base face 237 and apex 225of channel 235 such that the grooves have the same oblique anglerelative to a suture passing through channel 235, as shown in FIG. 5.Each groove 250 a-250 d has a first edge 253 a-253 d, respectively, anda second edge 254 a-254 d, respectively, oriented generally parallel tothe respective first edge and obliquely relative to the passage ofsuture 10 through channel 235.

Edges 253 a-253 d and 254 a-254 d, along with the shape of channel 235,act to permit suture to be pulled in a first direction while limitingmovement of the suture in a second opposite direction. Referring toFIGS. 4C and 5A, when suture 10 is pulled in the direction of arrow 11,contact of suture 10 with edges 253 a-253 d pushes suture 10 in adirection non-parallel to the direction of travel of suture 10 throughchannel 235. The action of edges 253 a-253 d upon suture 10 moves suture10 toward base face 227 into distal channel portion 237, allowing suture10 to pass through channel 235. When suture 10 is pulled in thedirection of arrow 12, contact of suture 10 with edges 254 a-254 dpushes suture 10 in a direction non-parallel to the direction of travelof suture 10 through channel 235. The action of edges 254 a-254 d uponsuture 10 moves suture 10 toward apex 225 into proximal restrictingportion 239, which acts to compress suture 10 and restrict passage ofsuture 10 through channel 235.

Referring to FIG. 6, one or more anchors 200 with suture 10 prethreadedthrough channel 235 can be deployed through tissue 300 into bone 302.During deployment, wings 219 a-219 d are initially compressed as theypass through corticol bone, and then expand into the cancellous bone toretain anchors 200 in the bone. By moving suture 10 in the direction ofarrow 11, the length of suture between two anchors 200 can be shortened,pulling suture 10 taught, while any tendency of the suture to loosen islimited by movement of suture 10 into proximal restricting portion 239of channel 235 in response to tension applied to suture 10 in thedirection of arrow 12. Suture guiding channel 235 and edges 253 a-253 dand 254 a-254 d in anchor 200 thus selectively restricts movement ofsuture 10 by allowing the passage of suture 10 through portion 237 ofchannel 235 in a first direction, while restricting subsequent passageof suture 10 in a second, opposite direction by engaging suture 10 inapex 225 at a substantially arbitrary position along the length of thesuture 10, without the need for an enlarged portion such as a knot inthe suture.

Further alternative embodiments are within the scope of the claims. Forexample, a single bone anchor can be used, or the suture can be fixed toa first anchor and coupled to a second anchor configured to selectivelyrestrict movement of the suture, as described above. A bone anchor caninclude only one or more than two cleats. Suture 10 can couple more thantwo bone anchors in a tissue repair system. Any of a number of differentgeometries and/or types of bone anchors as described in, e.g., U.S. Pat.No. 5,224,946 to Hayhurst et al., U.S. Pat. No. 5,236,455 to Hayhurst etal., and U.S. Pat. No. 5,100,417 to Cerier et al., the contents of allof which are incorporated herein by reference in their entirety, can bemodified to include means according to the invention for selectivelyrestricting passage of suture. Winding posts and side posts can bereplaced by any of a number of different structures that contact thesuture and retain it in the bone anchor, including eyelets, bosses, etc.Edges can be formed by ridges protruding from the side walls.

What is claimed is:
 1. A bone anchor comprising: an anchor bodyconfigured to be retained within bone, the anchor body defining a pathfor passage of a member through the anchor body, the anchor bodyincluding a restrictor defining an opening having a first portionpermitting passage of the member therethrough, and a second portionrestricting passage of the member therethrough, the restrictor beingconfigured such that movement of the member between the first and secondportions is not in a direction of passage of the member along the paththrough the anchor body.
 2. The bone anchor of claim 1 wherein therestrictor includes an edge lining a wall of the opening.
 3. The boneanchor of claim 2 wherein the edge is oriented obliquely to a directionof passage of the member through the opening.
 4. The bone anchor ofclaim 2 wherein the restrictor includes multiple edges lining the wallof the opening.
 5. The bone anchor of claim 4 wherein at least some ofthe edges are oriented at the same oblique angle relative to a directionof passage of the member through the opening.
 6. The bone anchor ofclaim 4 wherein at least some of the edges are oriented parallel to eachother.
 7. The bone anchor of claim 4 wherein the edges are located inthe first and second portion.
 8. The bone anchor of claim 1 wherein adimension of the second portion is narrower than a diameter of themember.
 9. The bone anchor of claim 1 wherein the opening is triangularin shape.
 10. The bone anchor of claim 1 configured such that the memberis movable between the first and second portions substantiallyperpendicularly to a direction of passage of the member through theopening.
 11. The bone anchor of claim 1 wherein the anchor body includesa tissue penetrating tip.
 12. The bone anchor of claim 1 wherein theanchor body includes a central body member.
 13. The bone anchor of claim12 wherein the central body includes a driver coupling.
 14. The boneanchor of claim 1 wherein the anchor body includes a resilient memberfor engaging bone tissue.
 15. The bone anchor of claim 14 wherein theresilient member has a sharp, proximal edge for penetrating bone tissue.16. The bone anchor of claim 1 wherein the anchor body includes multipleresilient members.
 17. The bone anchor of claim 1 wherein the anchorbody comprises a unitary body.
 18. The bone anchor of claim 1 whereinthe restrictor is configured such that moving the member along the pathin a first direction causes the member to be moved from the firstportion to the second portion.
 19. The bone anchor of claim 18 whereinthe restrictor is configured such that moving the member along the pathin a second direction opposite the first direction causes the member tobe moved from the second portion to the first portion.
 20. The boneanchor of claim 1 wherein the second portion is proximal to the firstportion.
 21. The bone anchor of claim 1 wherein the restrictor isconfigured such that when the member is within the second portion themember is restricted from moving along the path in a first direction.22. The bone anchor of claim 21 wherein the restrictor is configuredsuch that the member is moved from the second portion to the firstportion when the member is moved along the path in a second directionopposite the first direction.
 23. The bone anchor of claim 22 whereinthe restrictor is configured such that when the member is within thefirst portion, passage of the member along the path in the seconddirection is permitted.
 24. The bone anchor of claim 1 wherein therestrictor is configured such that movement of the member along the pathin a first direction acts to restrict passage of the member along thepath, and movement of the member along the path in a second directionacts to permit passage of the member along the path.
 25. A tissue repairsystem comprising: a first bone anchor including a first anchor bodyconfigured to be retained within bone, a second bone anchor including asecond anchor body configured to be retained within bone, and a flexiblemember coupling the first and second bone anchors, at least one of thefirst and second anchor bodies includes a restrictor defining an openinghaving a first portion for passage of the flexible member therethrough,and a second portion limiting passage of the flexible membertherethrough, the flexible member being movable between the first andsecond portions in a direction non-parallel to a direction of passage ofthe member through the opening.
 26. A bone anchor, comprising: an anchorbody configured to be retained within bone, the anchor body including arestrictor defining an opening for passage of a member therethrough, therestrictor including an edge lining a wall of the opening oriented suchthat upon movement of the member through the opening in a firstdirection, the member is also moved non-parallel to the first direction.27. The bone anchor of claim 26 wherein the edge is oriented such thatupon movement of the member through the opening in a second directionopposite the first direction, the member is also moved not along thepath.
 28. The bone anchor of claim 26 wherein the restrictor includes asecond edge lining the wall of the opening.
 29. A method comprising:placing a bone anchor in bone, the bone anchor defining a path forpassage of a member through the bone anchor, the bone anchor including arestrictor defining an opening having a first portion for permittingpassage of the member therethrough, and a second portion restrictingpassage of the member therethrough, and moving the member between thefirst and second portions not in a direction of passage of the memberalong the path through the anchor body.
 30. The method of claim 29further comprising engaging the member with an edge lining a wall of theopening.
 31. The method of claim 29 wherein moving the member to thesecond portion comprises moving the member in a direction substantiallyperpendicular to a direction moved by the member through the firstportion.
 32. The method of claim 29 further comprising placing a secondbone anchor in bone, the second bone anchor being coupled to the firstbone anchor by the member.